Accurate and precise manipulation of surgical instruments at or near a surgical site is required during any surgical procedure. However, this is especially true for minimally invasive endoscopic surgical procedures, such as laparoscopic surgery, in which the doctor has a limited amount of room to maneuver the instrument. While the following discussion relates to laparoscopies, it is equally applicable to any for endoscopic procedure.
As is well-known, laparoscopic surgery (laparoscopy) is a procedure in which surgical instruments and an endoscope, referred to normally as a laparoscope, are inserted into the abdominal cavity of a patient through a hollow tubular device positioned within a small incision in the patient. These tubular devices are commonly referred to as trocars or cannulas and remain in the incision throughout the procedure. The laparoscope comprises an illuminated tube and an optical system that is inserted through the tubular device in the abdominal wall for examining the abdominal cavity. The optical system includes an image receiving lens that can be connected to a remotely positioned monitor.
Endoscopes are presently hand held or positioned with complicated and expensive devices. They are constantly being repositioned to obtain the best view. When hand supported throughout the surgical procedure, the laparoscope must be constantly manually manipulated by the surgeon, assistant surgeon, and/or a scrub nurse in order to direct it at the target of the surgery. This process ties up one hand of the surgeon or assistant surgeon, if either holds the scope. The scrub nurses have other tasks to perform, and holding the scope interferes with performing these tasks. It is also difficult for the surgeon to direct others to position the scope for the best view. When the surgeon does not hold the scope, it is often misdirected. This can result in injury to the patient and delays in the conclusion of the surgery.
Mechanical support of a laparoscope has been provided conventionally using a robotic arm. However, these arms face many of the same problems encountered when the laparoscope is held by hand. For example, the movements of the laparoscope can be in the wrong direction and/or to an improper depth within the body. Additionally, these robotic systems can take up too much space in the operating room and require someone to constantly monitor and operate it. This unnecessarily ties up one of the members of the operating team and can contribute to crowding of the operation site. Additionally, many of the conventional systems allow the laparoscopes to bend and twist within the body, thereby stretching the incision.
Moreover, some conventional positioning systems typically attach to the instrument or laparoscope at a point above the trocar, which is approximately 4 to 8 inches above the abdomen wall. This creates a geometrical challenge to maintain an X and Y-axis pivot point at the incision of the abdominal wall and a stable image. Typically the above mentioned complicated and expensive mechanical linkages that extend over the patient are used to accomplish this positioning without any shaking of the image.